Kathleen Sebelius: Medicaid expansion’s not ‘bait and switch’

In a message targeted at states undecided about expanding Medicaid under the health care law, Department of Health and Human Services Secretary Kathleen Sebelius stressed Monday that the White House won’t back away from its promise to fund the expansions, even amid mounting battles over the federal budget.

Sebelius said states hesitant to sign up for the Medicaid expansion under the Affordable Care Act shouldn’t fear that the federal funding commitment will disappear when states boost their Medicaid rolls.

Sebelius spoke just hours before Ohio’s Gov. John Kasich became the fifth Republican governor to officially support the Medicaid expansion. Kasich, a former House Budget Committee chairman who has rejected a state-run health insurance exchange, said the decision would allow the state to direct its health care dollars toward mental health and other services.

Under the president’s health care law, the feds promised to fully fund the newly eligible population for three years starting in 2014. That match rate eventually will be nudged down to 90 percent over a decade, which is still significantly higher than the feds’ 57 percent average matching rate for the existing Medicaid program.

“I’d say it’s as good a deal as any state is going to get,” Sebelius said in prepared remarks at the National Health Policy Conference.

Many states, including some with governors who are big Obamacare backers, are worried that escalating federal budget battles will force major cuts in federally funded health care programs. So while the matching rate is much better than the norm, they’re skeptical it can last.

But the administration is drawing a hard line on Medicaid to prod more states to expand. Sebelius commented a few days after Gene Sperling, a top White House economic adviser, told a separate conference of health care advocates that President Barack Obama won’t support any major Medicaid cuts for the remainder of his administration.

“There’s a nervousness — an understandable nervousness — what if governors come into this system and then the federal budget deal changes the formula?” Sebelius said. “I think the president has made it very clear he understands this framework of payment is essential to giving governors the confidence that he’d oppose any change in that framework.”